Universal health care (UHC) is a noble goal and I fully
support it. Everyone will get sick somewhere in his/her lifetime so everyone
must have a health insurance. It does not mean though that UHC should be
implemented only or dominated by the government.

In the Philippines, there are no government carinderia or
restaurant corporation, or a government grocery or supermarket corporation, or
government tilapia or poultry or vegetable corporation, and yet people are
eating. So the food sector is a prime example that it is possible to serve the
public even if there is zero or little government involvement in direct service
provision. The key is product and price differentiation, market segmentation,
which allows various food producers and suppliers to serve various food
consumers with different taste, preference and budget.

UHC is attained if at least 85 percent of the total
Philippine population is covered by the Philippine Health Insurance Corporation
(PHIC or PhilHealth). Since its creation in 1995 and despite various schemes
from various administrations (Ramos, Estrada, Arroyo, Aquino), PhilHealth has
not attained that 85 percent beneficiary coverage. Last year though, PhilHealth
reported that it has finally achieved the UHC coverage.

I think there is something wrong with the above numbers.
PhilHealth assumes that most if not all members have dependents – legitimate
non-working spouse, legitimate children below 18 years old, and parents above
60 years old. This is not true.

Many members either do not have any dependent yet, or
have just one or two. For instance, parents who are either below or above 60
but still working are PhilHealth members themselves and cannot be declared as
dependents. If they have three children who are already working and have no
families yet, then that is equal to five members and all have no dependents.But
for PhilHealth , there are 10 to 15 people who are covered or enrolled as
beneficiaries already. I think this is dishonest math.

In the above table, PhilHealth made the following
multipliers: formal government x 3; formal private, OFWs and lifetime, x 2; IPP
x 2.3; Sponsored NHTS x 4.2, Sponsored LGUs x 3.7. So the 29.28 million members
translate to 81.63 million people or an average multiplier of 2.8.

If we compare labor force data from the National
Statistics Office (NSO), there is a big discrepancy with PhilHealth data.

As of October 2012, there were 40.43 million Filipinos in
the labor force, of which 37.67 million were employed and 2.76 million were
unemployed. If we just take the employed people as possible PhilHealth members,
there should be 37.7 million PhilHealth members.

This already shows an 8.4 million discrepancy with actual
or registered PhilHealth members. If the 2.6 million OFWs are not included as
they are not included in the NSO labor force survey data, plus the 0.6 million
lifetime members (mainly the senior citizens and retirees), the discrepancy
goes up to 11.6 million people, even assuming that the very poor, sponsored
individuals are all employed, which is not the case.

One way to correct this possible dishonesty in beneficiary
coverage is for PhilHealth to give a health card not only to registered members
but also to all their declared dependents. So that even babies and children
should have their own health cards too, to be presented to hospitals when they
are confined.

On another note, the Department of Health budget has been
ramping up recently, rising by around P10 billion a year from 2010 to 2013,
mainly to expand PhilHealth coverage of more than 5 million poor households who
are also in the CCT program of the DSWD.

On top of that, the mandatory contributions for each
member have been hiked except the lifetime members who pay none.

Then the hike in Sin Tax law or RA 10351 was recently
enacted. These three moves – hike in regular DOH budget, hike in PhilHealth
mandatory contributions, and higher revenues from higher taxes on tobacco and
alcohol products – mean even bigger money and role for government in
healthcare.

While “better government healthcare for the poor” looks
promising, promises are often different from reality. We go back to the above
discussion in the food sector where there is not a single government
corporation or agency involved in direct provision of food to the people and
yet people are eating. The trick is
competition among various food providers and suppliers, they bend backwards if
needed to attract more consumers. Competition is absent when government
monopolizes a service, like healthcare.

One alternative scheme that can reflect the reality in
the food sector, is for government to shift to health voucher system. Not this
year or the next, but a possibility that the DOH and PhilHealth can consider in
the near future. We will discuss this proposal in another paper as it will
require some elaborate explanation.

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These two tables below are part of Dr. Banzon's presentation but not included in the article above. It shows PhiliHealth funding with and without the Sin tax money as there was some uncertainty yet in late November whether the sin tax bill will become a law or not. With the enactment of the law (RA 10351) in mid-December 2012, they will be using the second table for PhilHealth spending this year and succeeding years.